ASHP InterSections ASHP InterSections

February 18, 2020

Active Pharmacists Use Exercise to Boost Health and Well-Being

Abhay Patel, Pharm.D., M.S., R.Ph.

AFTER FOUR MONTHS OF TRAINING for a half marathon, Abhay Patel, Pharm.D., M.S., R.Ph., Pharmacy Manager for Ambulatory Services at Children’s Hospital of Philadelphia, was amazed by not only improvements in his endurance and strength, but also by how his attitude about his work had changed. “Things that used to be a source of stress did not seem as stressful anymore,” he said.

Benefits of Exercise

As Dr. Patel and other pharmacists are finding out, staying fit can yield a multitude of rewards, from bolstering mental resilience to reducing symptoms of depression and anxiety. Staying fit through regular exercise is also one way individuals can address the problem of burnout, which over 50% of pharmacists in acute and ambulatory care settings experience.

The benefits of a fitness regimen became clear to Dr. Patel after he finished a short jog in the park near his home in the summer of 2015, during his PGY-2 residency. “At the end of that day, I looked back and realized I had accomplished even more than I normally did on a day without any deliberate physical activity,” recalled Dr. Patel, an ASHP member since 2011.

Fitness Journey

That realization left him wanting to exercise more. After completing residency and starting his job, he began to integrate short bike rides after work, weightlifting at his local fitness center, and taking advantage of his workplace’s wellness services. “I started by squeezing whatever I could into my day, and that laid the groundwork for establishing a more targeted, consistent routine,” he said.

As it turned out, squeezing in those bits of exercise yielded additional benefits. “My demeanor began to change positively, I had more energy, I was more focused on the tasks I was doing, and I felt better about myself and about the care I was providing, as well as my role as a team leader,” said Dr. Patel.

Exercising is not a panacea, he admitted, and his days include “all of the same highs and lows that I had before,” but his ability to manage these fluctuations has improved. There have been important changes in his perspective on work and life, Dr. Patel added. “It’s clearer to me that professionally and personally, it is not just about the pursuit of the finish line, but about pursuing progress instead,” he said. “It truly is a marathon, not a sprint, and about appreciating the journey.”

Yoga Unites Mind and Body

Jogs and gym visits are two ways to stay fit, but exercise can take other forms, as Christina Martin, Pharm.D., M.S., CAE, ASHP’s Director, New Practitioners Forum, has shown.

Christina Martin, Pharm.D., M.S., CAE

Dr. Martin started practicing yoga roughly seven years ago, an interest she developed when she began her first post-residency pharmacy supervisor position and fell into the trap of working too much. “Things went out of balance,” she said. “Yoga was something that I could commit to beyond work.” Over the years, Dr. Martin has learned to enjoy not only the physical aspects of yoga but also its inward, meditative focus.

“The Sanskrit word for yoga is ‘yuj,’ which means to control or to unite, and that is what my yoga practice has transformed into – controlling the noise from the outside world and uniting my mind, body, and soul,” said Dr. Martin. “One of my teachers regularly reminds us that coming to the yoga mat is an escape to our own private island.”

Yoga has also added another layer of meaning to her life, she said, as she recently completed a hot yoga teacher training program so that she can share her passion for the practice with others. The 200-hour training program included learning about human anatomy, how to address common ailments that yoga practitioners face, as well as studies in yogic breathing, nutrition, and chakra theory. A chakra is a center of spiritual power in Hindu thought.

“Being part of any community – including the yoga community – can be an antidote to the pervasive isolation and loneliness that we see in today’s society,” Dr. Martin said.

CrossFit Champ

A strong sense of community built around the goals of fitness is one reason Robert Weber, Pharm.D., M.S., FASHP, Chief Pharmacy Officer at the Ohio State University Wexner Medical Center in Columbus, Ohio, has fallen in love with CrossFit, a high-intensity form of exercise.

Robert Weber, Pharm.D., M.S., FASHP

As Dr. Weber recalls, his journey toward developing a rigorous CrossFit regimen began after years of struggling with weight gain as well as complications from a colon cancer diagnosis in 2008 and chemotherapy and surgery that eradicated his cancer, but left him with neuropathic pain in his hands and feet.

“I was told that I should not and could not [do any vigorous exercise] because of the neuropathy and that walking with some light yoga was sufficient,” said Dr. Weber, an ASHP Fellow and member since 1980. He assumed his physicians were right, because at the time, “I wasn’t able to balance myself, jump, and do all the things that are part of exercising.”

With the neuropathic pain limiting his ability to exercise, Dr. Weber tried to stay healthy through a proper diet, but eight years of a sedentary lifestyle left him overweight, and in need of cardiovascular medications, he said.

“The turning point for me came when my brother died of cancer in 2017,” Dr. Weber recalled. “I was standing over his grave, and I said to myself, ‘I need to make a change and start exercising again and move the dial in terms of my overall health and wellness.’”

His daughter urged Dr. Weber, who is now 63, to take CrossFit classes. While the exercise leaves him feeling “tired and winded, once I’m done, I feel like a million bucks,” he said. Dr. Weber noted that he overcame the neuropathic pain in his feet by increasing the frequency and intensity of the exercises in “baby steps, and not pushing too hard at first.”

Today, as a result of regular exercise and proper nutrition, Dr. Weber is 42 pounds lighter and has been able to discontinue most of his cardiovascular and neuropathic pain drugs. “I’m now more stable on my feet, more confident, and I make better decisions at work,” he added.

For those in his age group interested in starting an exercise regimen, Dr. Weber cautioned first to get a physician’s approval and also to start at a low intensity. He noted that a personal trainer or coach has the expertise to design a safe exercise program customized to your needs. This is important because performing too many repetitions too early can cause cardiac stress, he said, and lifting too much weight initially can lead to several days of discomfort and possibly serious injury.

“Particularly at my age, it can be frustrating if you start an exercise program and get stiff and sore for a few days,” said Dr. Weber. “I’ve seen many people my age quit after a brief time because they can’t tolerate the soreness that follows exercising.”

With those caveats in mind, Dr. Weber believes that almost anyone of any age can build an exercise regimen that works for them and reap the benefits. “You can do anything you set your mind to do,” he said.

 

By David Wild

 

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July 31, 2018

Ohio Pharmacists Overhaul Drug Shortage Strategy

Wexner’s Crystal Tubbs (left) and Hannah Miller (right) participate in a meeting about drug shortages.

AS DRUG SHORTAGES CONTINUE TO AFFECT PATIENT CARE, health systems and hospitals across the country have begun to take steps to buffer the impact of additional medication scarcities. Pharmacists at the Ohio State University Wexner Medical Center spearheaded an approach in November 2017 to improve the organization’s response to drug shortages. The initiative focuses on rapid communication among all staff involved in the medication-use process.

Crystal Tubbs, Pharm.D., FASHP, is the Associate Director of Wexner’s Department of Pharmacy. After Hurricanes Irma and Maria damaged manufacturing facilities in Puerto Rico, which left organizations without access to small-volume parenterals and other critical drugs, Dr. Tubbs and the pharmacy staff took the lead in revamping Wexner’s drug shortage management strategy.

“Our previous process was to hold weekly drug shortage meetings, mostly with purchasing and operational staff. However, clinical staff began telling us they felt ill-informed to make operational and clinical changes when a shortage hit,” said Dr. Tubbs, an ASHP member since 2000.

In response to this feedback, Dr. Tubbs and her colleagues organized a retreat with roughly 75 staff members representing departments from across the medical center. The discussions at the retreat led to a number of significant changes, she said. “We now have two weekly drug shortage meetings that include not only pharmacy purchasing and operational leaders, but also senior pharmacy administrators, our drug information team, pharmacy technicians, pharmacy representatives from each clinical area in the hospital, medication safety experts, and information technology [IT] staff,” Dr. Tubbs explained. “Now, more people feel like they’re in the know.”

EMR Tools

To expedite the communication of drug shortage information, the team drew heavily on tools in the electronic medical record (EMR) system. “We created a drug shortage database that has become our source of truth for up-to-date and real-time information on clinical and operational action plans,” Dr. Tubbs said, adding that ASHP’s drug shortage resources often help her staff decide how to manage shortages.

Crystal Tubbs, Pharm.D., FASHP

The medical center also recently launched an EMR-integrated inventory management system that pharmacy staff across the health system can access to find real-time information about the inventory of any medication.

In addition, Dr. Tubbs and her team added banners on the EMR’s login page to convey particularly important information. “A red banner at the top of the login screen communicates urgent clinical and operational changes, and a tan banner lets staff know about less urgent measures or if a shortage has been resolved,” said Dr. Tubbs. This tool has been particularly useful in cases where actions need to be implemented quickly because a medication shortage has become critical, she noted.

Any information that is not included in the database or conveyed through banners is now sent out through a centralized drug shortage email account. According to Dr. Tubbs, the medical center’s staff members feel that this new process is “seamless and consistent” compared to the previous method, which included multiple emails from a number of accounts. “It has simplified the process for staff looking for answers to their drug shortage questions, because they can now query the single email account,” said Dr. Tubbs.

A Well-Oiled Machine

According to Hannah Miller, CPh.T., CMRP, Purchasing Manager in Wexner’s Department of Pharmacy, the new drug management process runs “like a well-oiled machine.” She added that the timing of communication with the old approach sometimes delayed an effective response and was an incomplete response to a drug shortage. The purchasing team would reach out to clinical staff only if they needed to find an alternative medication or if a shortage required a product switch or a more restrictive prescribing process.

“For example, when methylene blue 1% was discontinued in November 2016, following approval from our clinical staff, we switched to a 0.5% concentration from another manufacturer, but the transition didn’t go over very well at first,” she recalled.

Unlike the 1% concentration, which had to be mixed with saline, the 0.5% product had to be prepared with dextrose and, since it was a different concentration, the product fell under a different drug entry. “Those changes led to some hiccups, especially for our IT team and clinical staff,” said Miller. “Although the purchasing staff was able to get the necessary products through the door, we struggled to operationalize the changes associated with the alternatives on our own.”

Ultimately, they worked through the challenges by assembling methylene blue 0.5% kits that included dextrose, she explained. “With the new process in place, clinical and IT staff members are involved right from the beginning, and we manage drug shortages much more effectively,” Miller reflected.

Strategic Measures

The new approach, which elicited a “resoundingly positive” response from staff, was a boon for the hospital when it faced intravenous (IV) opioid shortages in November 2017.

“As soon as we were notified of the shortages, we held an emergency meeting to evaluate stock as well as the predicted availability of more medications and the number of days of supply on hand, which we found was quite low for several different medications,” said Dr. Tubbs.

In short order, staff developed a plan for each opioid, recommending measures like switching from IV to oral administration, or evaluating other non-opioid strategies for pain management. They also used the EMR banners to encourage clinicians to order patient-controlled anaesthesia judiciously and to select alternative agents for continuous pain management in the intensive care unit. Each time an affected opioid was prescribed, an electronic alert was triggered, and the drug shortage database was updated daily. Clinical pharmacists reviewed daily reports that listed all patients with active IV opiate orders. “Within 48 hours of implementing the restrictions, we had reduced IV opiate administration by over 50 percent,” Dr. Tubbs recalled.

Pharmacy Technicians’ Role

Miller noted that pharmacy technicians have long been important members of the drug shortage team. In addition to being the pharmacy’s buyers and purchasing managers, technicians on the hospital floors provided useful input that helped shape a drug shortage management strategy, she explained.

For example, when the hospital faced a shortage of emergency syringes in April 2017, crash cart technicians pointed out they rarely used the five syringes of epinephrine typically stocked in each cart. They also said they could turn to epinephrine vials stocked in the carts and automated dispensing cabinets, if needed. “They suggested that we reduce the number of syringes per cart to three,” Miller said. “Our clinical pharmacists agreed with that decision.” This insight freed up syringes to use with other injectable medications.

Comfort with the Unpredictable

Using a comprehensive and team-based approach to managing drug shortages that now draws on a variety of tools and strategies, Wexner has proven that, although shortages are inevitable, their impact can be mitigated. “Shortages are still uncomfortable,” said Dr. Tubbs, “but we are fortunate that we haven’t completely run out of any specific medications since changing our approach and improving how we communicate information on drug shortages.”

 

By David Wild

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